|
TIB/PER REVASC W/TLA
|
Facility
|
IP
|
$5,500.00
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
76101552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$715.00 |
| Max. Negotiated Rate |
$5,280.00 |
| Rate for Payer: Aetna Commercial |
$4,235.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,290.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$4,565.00
|
| Rate for Payer: First Health Commercial |
$5,225.00
|
| Rate for Payer: Humana Commercial |
$4,675.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,510.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,059.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,840.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,125.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.00
|
| Rate for Payer: PHCS Commercial |
$5,280.00
|
| Rate for Payer: United Healthcare All Payer |
$4,840.00
|
|
|
TIB/PER REVASC W/TLA(P
|
Professional
|
Both
|
$5,500.00
|
|
|
Service Code
|
HCPCS 37228
|
| Hospital Charge Code |
761P1552
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$289.32 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$959.61
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$289.32
|
| Rate for Payer: Anthem Medicaid |
$512.70
|
| Rate for Payer: Buckeye Medicare Advantage |
$5,500.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cash Price |
$2,750.00
|
| Rate for Payer: Cigna Commercial |
$1,086.08
|
| Rate for Payer: Healthspan PPO |
$5,062.57
|
| Rate for Payer: Humana Medicaid |
$512.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$748.06
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$522.95
|
| Rate for Payer: Molina Healthcare Passport |
$512.70
|
| Rate for Payer: Multiplan PHCS |
$3,300.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$3,850.00
|
| Rate for Payer: UHCCP Medicaid |
$303.79
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$517.83
|
|
|
TIB PLATE L LAT PROX JIG HEAD
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB PLATE L LAT PROX JIG HEAD
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB PLATE L LAT PROX JIG TAIL
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIB PLATE L LAT PROX JIG TAIL
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
TIE-IN TRAPEZIUM KIT
|
Facility
|
OP
|
$8,913.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.79 |
| Max. Negotiated Rate |
$8,557.20 |
| Rate for Payer: Aetna Commercial |
$6,863.59
|
| Rate for Payer: Anthem Medicaid |
$3,065.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.72
|
| Rate for Payer: Cash Price |
$4,456.88
|
| Rate for Payer: Cigna Commercial |
$7,398.41
|
| Rate for Payer: First Health Commercial |
$8,468.06
|
| Rate for Payer: Humana Commercial |
$7,576.69
|
| Rate for Payer: Humana KY Medicaid |
$3,065.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.26
|
| Rate for Payer: PHCS Commercial |
$8,557.20
|
| Rate for Payer: United Healthcare All Payer |
$7,844.10
|
|
|
TIE-IN TRAPEZIUM KIT
|
Facility
|
IP
|
$8,913.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.79 |
| Max. Negotiated Rate |
$8,557.20 |
| Rate for Payer: Aetna Commercial |
$6,863.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.72
|
| Rate for Payer: Cash Price |
$4,456.88
|
| Rate for Payer: Cigna Commercial |
$7,398.41
|
| Rate for Payer: First Health Commercial |
$8,468.06
|
| Rate for Payer: Humana Commercial |
$7,576.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,309.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,578.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,674.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,844.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,685.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,782.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,158.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,763.26
|
| Rate for Payer: PHCS Commercial |
$8,557.20
|
| Rate for Payer: United Healthcare All Payer |
$7,844.10
|
|
|
TIE-IN TRAPEZIUM KIT SIZE 1
|
Facility
|
OP
|
$11,961.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.99 |
| Max. Negotiated Rate |
$11,482.99 |
| Rate for Payer: Aetna Commercial |
$9,210.32
|
| Rate for Payer: Anthem Medicaid |
$4,113.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,329.93
|
| Rate for Payer: Cash Price |
$5,980.73
|
| Rate for Payer: Cigna Commercial |
$9,928.00
|
| Rate for Payer: First Health Commercial |
$11,363.38
|
| Rate for Payer: Humana Commercial |
$10,167.23
|
| Rate for Payer: Humana KY Medicaid |
$4,113.54
|
| Rate for Payer: Kentucky WC Medicaid |
$4,155.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,808.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,827.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,588.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,196.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,526.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,971.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.05
|
| Rate for Payer: PHCS Commercial |
$11,482.99
|
| Rate for Payer: United Healthcare All Payer |
$10,526.08
|
|
|
TIE-IN TRAPEZIUM KIT SIZE 1
|
Facility
|
IP
|
$11,961.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.99 |
| Max. Negotiated Rate |
$11,482.99 |
| Rate for Payer: Aetna Commercial |
$9,210.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,329.93
|
| Rate for Payer: Cash Price |
$5,980.73
|
| Rate for Payer: Cigna Commercial |
$9,928.00
|
| Rate for Payer: First Health Commercial |
$11,363.38
|
| Rate for Payer: Humana Commercial |
$10,167.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,808.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,827.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,588.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,526.08
|
| Rate for Payer: Ohio Health Group HMO |
$8,971.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,392.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.05
|
| Rate for Payer: PHCS Commercial |
$11,482.99
|
| Rate for Payer: United Healthcare All Payer |
$10,526.08
|
|
|
TIE-IN TRAPEZIUM KIT SIZE 2
|
Facility
|
OP
|
$10,797.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.62 |
| Max. Negotiated Rate |
$10,365.22 |
| Rate for Payer: Aetna Commercial |
$8,313.77
|
| Rate for Payer: Anthem Medicaid |
$3,713.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,421.74
|
| Rate for Payer: Cash Price |
$5,398.55
|
| Rate for Payer: Cigna Commercial |
$8,961.59
|
| Rate for Payer: First Health Commercial |
$10,257.24
|
| Rate for Payer: Humana Commercial |
$9,177.54
|
| Rate for Payer: Humana KY Medicaid |
$3,713.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,750.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,853.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,239.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,787.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,501.45
|
| Rate for Payer: Ohio Health Group HMO |
$8,097.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,159.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,347.10
|
| Rate for Payer: PHCS Commercial |
$10,365.22
|
| Rate for Payer: United Healthcare All Payer |
$9,501.45
|
|
|
TIE-IN TRAPEZIUM KIT SIZE 2
|
Facility
|
IP
|
$10,797.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.62 |
| Max. Negotiated Rate |
$10,365.22 |
| Rate for Payer: Aetna Commercial |
$8,313.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,421.74
|
| Rate for Payer: Cash Price |
$5,398.55
|
| Rate for Payer: Cigna Commercial |
$8,961.59
|
| Rate for Payer: First Health Commercial |
$10,257.24
|
| Rate for Payer: Humana Commercial |
$9,177.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,853.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,239.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,501.45
|
| Rate for Payer: Ohio Health Group HMO |
$8,097.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,159.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,347.10
|
| Rate for Payer: PHCS Commercial |
$10,365.22
|
| Rate for Payer: United Healthcare All Payer |
$9,501.45
|
|
|
TIE-IN TRAPEZIUM KIT SIZE 3
|
Facility
|
OP
|
$10,797.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.62 |
| Max. Negotiated Rate |
$10,365.22 |
| Rate for Payer: Aetna Commercial |
$8,313.77
|
| Rate for Payer: Anthem Medicaid |
$3,713.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,421.74
|
| Rate for Payer: Cash Price |
$5,398.55
|
| Rate for Payer: Cigna Commercial |
$8,961.59
|
| Rate for Payer: First Health Commercial |
$10,257.24
|
| Rate for Payer: Humana Commercial |
$9,177.54
|
| Rate for Payer: Humana KY Medicaid |
$3,713.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,750.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,853.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,239.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,787.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,501.45
|
| Rate for Payer: Ohio Health Group HMO |
$8,097.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,159.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,347.10
|
| Rate for Payer: PHCS Commercial |
$10,365.22
|
| Rate for Payer: United Healthcare All Payer |
$9,501.45
|
|
|
TIE-IN TRAPEZIUM KIT SIZE 3
|
Facility
|
IP
|
$10,797.10
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.62 |
| Max. Negotiated Rate |
$10,365.22 |
| Rate for Payer: Aetna Commercial |
$8,313.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,421.74
|
| Rate for Payer: Cash Price |
$5,398.55
|
| Rate for Payer: Cigna Commercial |
$8,961.59
|
| Rate for Payer: First Health Commercial |
$10,257.24
|
| Rate for Payer: Humana Commercial |
$9,177.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,853.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,968.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,239.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,501.45
|
| Rate for Payer: Ohio Health Group HMO |
$8,097.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,159.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,347.10
|
| Rate for Payer: PHCS Commercial |
$10,365.22
|
| Rate for Payer: United Healthcare All Payer |
$9,501.45
|
|
|
TIGAN (TRIMETHOBENZ. 200MG/2ML
|
Facility
|
IP
|
$321.72
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
25002390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$308.85 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.94
|
| Rate for Payer: Cash Price |
$160.86
|
| Rate for Payer: Cigna Commercial |
$267.03
|
| Rate for Payer: First Health Commercial |
$305.63
|
| Rate for Payer: Humana Commercial |
$273.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.11
|
| Rate for Payer: Ohio Health Group HMO |
$241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.73
|
| Rate for Payer: PHCS Commercial |
$308.85
|
| Rate for Payer: United Healthcare All Payer |
$283.11
|
|
|
TIGAN (TRIMETHOBENZ. 200MG/2ML
|
Facility
|
OP
|
$321.72
|
|
|
Service Code
|
HCPCS J3250
|
| Hospital Charge Code |
25002390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$308.85 |
| Rate for Payer: Aetna Commercial |
$247.72
|
| Rate for Payer: Anthem Medicaid |
$110.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$250.94
|
| Rate for Payer: Cash Price |
$160.86
|
| Rate for Payer: Cigna Commercial |
$267.03
|
| Rate for Payer: First Health Commercial |
$305.63
|
| Rate for Payer: Humana Commercial |
$273.46
|
| Rate for Payer: Humana KY Medicaid |
$110.64
|
| Rate for Payer: Kentucky WC Medicaid |
$111.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$263.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$237.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$96.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$283.11
|
| Rate for Payer: Ohio Health Group HMO |
$241.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$64.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$41.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$99.73
|
| Rate for Payer: PHCS Commercial |
$308.85
|
| Rate for Payer: United Healthcare All Payer |
$283.11
|
|
|
TIGECYCLINE 1mg (50mg SDV)
|
Facility
|
IP
|
$572.25
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
25002387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$549.36 |
| Rate for Payer: Aetna Commercial |
$440.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.36
|
| Rate for Payer: Cash Price |
$286.12
|
| Rate for Payer: Cigna Commercial |
$474.97
|
| Rate for Payer: First Health Commercial |
$543.64
|
| Rate for Payer: Humana Commercial |
$486.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.58
|
| Rate for Payer: Ohio Health Group HMO |
$429.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.40
|
| Rate for Payer: PHCS Commercial |
$549.36
|
| Rate for Payer: United Healthcare All Payer |
$503.58
|
|
|
TIGECYCLINE 1mg (50mg SDV)
|
Facility
|
OP
|
$572.25
|
|
|
Service Code
|
HCPCS J3243
|
| Hospital Charge Code |
25002387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.39 |
| Max. Negotiated Rate |
$549.36 |
| Rate for Payer: Aetna Commercial |
$440.63
|
| Rate for Payer: Anthem Medicaid |
$196.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$446.36
|
| Rate for Payer: Cash Price |
$286.12
|
| Rate for Payer: Cigna Commercial |
$474.97
|
| Rate for Payer: First Health Commercial |
$543.64
|
| Rate for Payer: Humana Commercial |
$486.41
|
| Rate for Payer: Humana KY Medicaid |
$196.80
|
| Rate for Payer: Kentucky WC Medicaid |
$198.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$469.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$422.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$171.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$200.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$503.58
|
| Rate for Payer: Ohio Health Group HMO |
$429.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$114.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$74.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$177.40
|
| Rate for Payer: PHCS Commercial |
$549.36
|
| Rate for Payer: United Healthcare All Payer |
$503.58
|
|
|
TIGEREYE CTO CROSSING CATHETER
|
Facility
|
OP
|
$12,406.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.88 |
| Max. Negotiated Rate |
$11,910.48 |
| Rate for Payer: Aetna Commercial |
$9,553.20
|
| Rate for Payer: Anthem Medicaid |
$4,266.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,677.26
|
| Rate for Payer: Cash Price |
$6,203.38
|
| Rate for Payer: Cigna Commercial |
$10,297.60
|
| Rate for Payer: First Health Commercial |
$11,786.41
|
| Rate for Payer: Humana Commercial |
$10,545.74
|
| Rate for Payer: Humana KY Medicaid |
$4,266.68
|
| Rate for Payer: Kentucky WC Medicaid |
$4,310.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,173.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,156.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.94
|
| Rate for Payer: Ohio Health Group HMO |
$9,305.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,846.09
|
| Rate for Payer: PHCS Commercial |
$11,910.48
|
| Rate for Payer: United Healthcare All Payer |
$10,917.94
|
|
|
TIGEREYE CTO CROSSING CATHETER
|
Facility
|
IP
|
$12,406.75
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
27000013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,612.88 |
| Max. Negotiated Rate |
$11,910.48 |
| Rate for Payer: Aetna Commercial |
$9,553.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,677.26
|
| Rate for Payer: Cash Price |
$6,203.38
|
| Rate for Payer: Cigna Commercial |
$10,297.60
|
| Rate for Payer: First Health Commercial |
$11,786.41
|
| Rate for Payer: Humana Commercial |
$10,545.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,173.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,156.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,722.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,917.94
|
| Rate for Payer: Ohio Health Group HMO |
$9,305.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,481.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,846.09
|
| Rate for Payer: PHCS Commercial |
$11,910.48
|
| Rate for Payer: United Healthcare All Payer |
$10,917.94
|
|
|
TIGERLOOP #2 WT/GR ST AR-7234T
|
Facility
|
IP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
TIGERLOOP #2 WT/GR ST AR-7234T
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
TIGER RADIAL CATH
|
Facility
|
IP
|
$757.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.48 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna Commercial |
$583.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.85
|
| Rate for Payer: Cash Price |
$378.75
|
| Rate for Payer: Cigna Commercial |
$628.72
|
| Rate for Payer: First Health Commercial |
$719.62
|
| Rate for Payer: Humana Commercial |
$643.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.60
|
| Rate for Payer: Ohio Health Group HMO |
$568.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.82
|
| Rate for Payer: PHCS Commercial |
$727.20
|
| Rate for Payer: United Healthcare All Payer |
$666.60
|
|
|
TIGER RADIAL CATH
|
Facility
|
OP
|
$757.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.48 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna Commercial |
$583.28
|
| Rate for Payer: Anthem Medicaid |
$260.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.85
|
| Rate for Payer: Cash Price |
$378.75
|
| Rate for Payer: Cigna Commercial |
$628.72
|
| Rate for Payer: First Health Commercial |
$719.62
|
| Rate for Payer: Humana Commercial |
$643.88
|
| Rate for Payer: Humana KY Medicaid |
$260.50
|
| Rate for Payer: Kentucky WC Medicaid |
$263.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$265.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.60
|
| Rate for Payer: Ohio Health Group HMO |
$568.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.82
|
| Rate for Payer: PHCS Commercial |
$727.20
|
| Rate for Payer: United Healthcare All Payer |
$666.60
|
|
|
TIGER RADIAL CATH 5FR 4.0
|
Facility
|
IP
|
$757.50
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
27000040
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.48 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Aetna Commercial |
$583.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$590.85
|
| Rate for Payer: Cash Price |
$378.75
|
| Rate for Payer: Cigna Commercial |
$628.72
|
| Rate for Payer: First Health Commercial |
$719.62
|
| Rate for Payer: Humana Commercial |
$643.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$621.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$559.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$227.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$666.60
|
| Rate for Payer: Ohio Health Group HMO |
$568.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$151.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$98.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$234.82
|
| Rate for Payer: PHCS Commercial |
$727.20
|
| Rate for Payer: United Healthcare All Payer |
$666.60
|
|
